Preservative-free IOP-lowering medications: potential advantages

I.B. Alekseev1, I.A. Koroleva2 1Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation 2City Clinical Hospital No. 15, Moscow, Russian Federation According to the World Health Organization, glaucoma is the second leading cause of blindness in the world. Pharmacotherapy for glaucoma implies long-term instillations of IOP-lowering drugs. However, more glaucoma medications per day are required with time. In these cases, fixed-dose combinations containing several active ingredients are beneficial. Potential advantages of fixed-dose combinations include reduced costs, lower risk of washout, less instillations, reduced medication regimen complexity, and saved time. This results in better treatment compliance. Reduced preservative exposure is important as well. Many studies have demonstrated that preservatives induce local adverse reactions. Elimination or minimization of adverse reactions accompanying long-term glaucoma therapy is an important resource to improve treatment compliance and, therefore, to prevent vision loss and to maintain the quality of life. Hence, glaucoma patients may benefit from the avoidance of the addit ional risk of ocular surface disorders resulting from preservative exposure. Keywords: glaucoma, intraocular pressure, monotherapy, combined treatment, fixed-dose combinations, prostaglandin analogues, ocular surface, compliance, tafluprost, Tapticom. For citation: Alekseev I.B., Koroleva I.A. Preservative-free IOP-lowering medications: potential advantages. Russian Journal of Clinical Ophthalmology. 2019;19(3):137–142. About the authors: 1Igor B.&nbsp;Alekseev — MD, PhD, Professor, ORCID iD 0000-0002-4506-4986; 2Irina A.&nbsp;Koroleva — MD, PhD, ophthalmologist, ORCID iD 0000-0003-1679-5701. 1Russian Medical Academy of Continuous Professional Education. 2/1, Barrikadnaya str., Moscow, 125993, Russian Federation. 2City Clinical Hospital No. 15. 23, Veshnyakovskaya str., Moscow, 111539, Russian Federation. Contact information:&nbsp;Irina&nbsp;A.&nbsp;Koroleva, e-mail:&nbsp;[email protected].&nbsp;Financial Disclosure:&nbsp;no author has a financial or property interest in any material or method mentioned. There is no&nbsp;conflict of interests. Received&nbsp;24.06.2019. </p

Prolonging IOP-lowering effect of glaucoma surgery

Currently, glaucoma surgery is considered as primary but not reserve treatment option. The paper reviews historical aspects of glaucoma&nbsp;surgery, important milestones of technique development, and domestic and foreign published data on major surgical procedures for glaucoma, complications of glaucoma filtering surgery, and methods to prevent postoperative scarring. Special attention is paid to glaucoma surgical procedures. It was demonstrated that sinus trabeculectomy is more effective than non-penetrating procedures after 6 and 12 months. Complications of sinus trabeculectomy, risk factors for filtering bleb scarring, and diagnosis of novel pathway obliteration (which reduces the efficacy of glaucoma filtering surgery) are discussed. Recent approaches to prevent filtering bleb scarring using implants, drainage devices, and cytostatic agents are addressed. In Russia, antimetabolite administration is limited since these drugs are not approved for subconjunctival injections. Bleb needling revision is the most promising, simple, and minimally invasive technique to prevent scarring after fistulizing procedures.&nbsp; Keywords: glaucoma, glaucoma surgery, sinus trabeculectomy, filtering bleb, needling revision, complications, optical coherence tomography.&nbsp; For citation: Alekseev I.B., Samoylenko A.I., Aylarova А.К. Prolonging IOP-lowering effect of glaucoma surgery. Russian Journal of Clinical Ophthalmology. 2019;19(2):93–98. About the authors: 1Igor B. Alekseev — MD, PhD, Professor of the Department of Ophthalmology, ORCID iD 0000-0002-3906-0479; 2Alexander I. Samoylenko — MD, PhD, Head of Vitreoretinal Department, ORCID iD 0000-0002-5796-6012; 1Agunda K. Aylarova — postgraduate student of the Department of Ophthalmology, ORCID iD 0000-0002-9709-4693. 1Russian Medical Academy of Continuous Professional Edu- cation. 2/1, Barrikadnaya str., Moscow, 125993, Russian Federation. 2S.P. Botkin City Clinical Hospital, Branch No. 1, Ophthalmological Clinical Hospital. 7, Mamonoskiy Lane, Moscow, 123001, Russian Federation Contact information:&nbsp;Agunda K. Aylarova, e-mail:&nbsp;[email protected].&nbsp;Financial Disclosure:&nbsp;no author has a financial or property interest in any material or method mentioned. There is no&nbsp;conflict of interests. Received&nbsp;02.03.2019.&nbsp;</i

Characteristics of glaucoma therapy with prostaglandin analogues nowadays

I.B. Alekseev1, A.V. Volkova1, L.I. Alekseeva2 1Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation 2I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation Ocular hypotensive prostaglandin analogues (PGAs) are prodrugs that penetrate the cornea and become biologically active after hydrolysis by corneal esterase. They reduce intracranial pressure by increasing the uveoscleral outflow of aqueous humour and decreasing the outflow resistance. PGAs remain relevant as the first-line therapy drugs for patients with newly diagnosed glaucoma. The obvious exposure drawbacks of eye drops with preservatives have become prerequisites for the use of preservative-free medicines. Currently, it is recommended to use eye drops with preservatives less commonly, in the ideal case — only preservative-free products. In turn, the production of preservative-free drugs requires suitable carriers for the medicinal substance delivery — special vials (that do not depressurize when used) or monodoses. At present, reusable polymer dropper bottles have been developed, equipped with a valve that excludes the fluid intake return, a nozzle with ant ibacterial elements and an embedded sterilizing air filter. In the pharmaceutical market, travoprost is presented in the dosage form of eye drops, 0.04 mg/mL. This drug implements the described mechanism of drug storage and delivery. The review presents a meta-analysis on the comparative efficacy and tolerability of travoprost. Preservative-free travoprost presence on the pharmaceutical market in a special vial expands the range of available anti-glaucoma drugs. Keywords: glaucoma, hypotensive therapy, preservative-free dosage forms, prostaglandin analogues, travoprost. For citation: Alekseev I.B., Volkova A.V., Alekseeva L.I. Characteristics of glaucoma therapy with prostaglandin analogues nowadays. Russian Journal of Clinical Ophthalmology. 2022;22(3):175–180 (in Russ.). DOI: 10.32364/2311-7729-2022-22-3-175-180. </p

Blepharoplasty: historical aspects, terminology, and modern ideas

A.D. Kazantsev, E.P. Kazantseva, I.B. Alekseev Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation Visual contact is one of the important aspects of non-verbal communication. The look of every person is unique, it emphasizes individuality and represents what is happening in the inside and emotional experience. When we look in the eyes, we gain our first impression of an interlocutor and his/her psych evaluation. Irreversible changes of periorbital tissues of the upper face occur with aging. They result in the functional changes and visible cosmetic defects, thereby negatively affecting psychological social status and provoking eyelid discomfort. Patients refer to specialists (plastic or ocular surgeons) to address these age-related issues. Blepharoplasty is a popular, effective, and safe surgical procedure to reconstruct periorbital soft tissues. The history of blepharoplasty began in the 10th century when a Persian scientist Avicenna described a technique of removing the excessive overhanging skin of the upper lids. Later on, blepharoplasty goes through a long way of development, evolution, and practice. Blepharoplasty is no less important today, being one of the most common esthetic procedures of plastic surgery worldwide. Modern, highly effective diagnostic tools and professional medical equipment allow for an accurate prediction of surgical outcome, thereby emphasizing the importance of the conception "desired changes — realistic expectations". This paper reviews the historic aspects and current views on blepharoplasty, and professional terminology used by plastic and ocular surgeons specializing in esthetic eyelid surgery. Keywords: blepharoplasty, history of blepharoplasty, plastic surgery, eye surgery, periorbital area, professional terminology, current ideas, preoperative planning, reconstruction of eyelid soft tissues. For citation: Kazantsev A.D., Kazantseva E.P., Alekseev I.B. Blepharoplasty: historical aspects, terminology, and modern ideas. Russian Journal of Clinical Ophthalmology. 2022;22(2):127–131 (in Russ.). DOI: 10.32364/2311-7729-2022-22-2-127-131. </p

Improving effectiveness of glaucoma screening during prophylactic medical examinations: current approaches

M.A.&nbsp;Kazanfarova1,2, I.B.&nbsp;Alekseev1, A.L.&nbsp;Lindenbraten3, S.A.&nbsp;Kochergin1 1Russian Medical Academy of Continuous Professional Education, &nbsp;Moscow, Russian Federation 2The International Medical Cluster Foundation, Moscow, Russian Federation 3N.A.&nbsp;Semashko National Research Institute of Public Health, Moscow, Russian Federation Background: early diagnosis of diseases in clinically healthy persons is the basis of prophylactic medical examinations. In addition to cardiovascular disorders, cancer, diabetes, and chronic lung diseases, glaucoma is one of the major causes of disability in Russian Federation. Prophylactic medical examinations for glaucoma are less addressed in domestic published data than for other diseases which results in disability and early death. Aim: to assess the effectiveness of screening for glaucoma in Russian Federation, to uncover ineffective areas, and to suggest potential solutions. Materials and Methods: the 35-item questionnaire for ophthalmologists who provide primary ocular care was developed (screening questions are addressed below). Survey responses from 126 ophthalmologists who provide primary ocular care were anonymous. Results: 37% of respondents consider prophylactic medical examinations effective while 63% consider prophylactic medical examinations ineffective. Currently, glaucoma is diagnosed more often at early stages, i.e., 34% of respondents diagnose glaucoma at early stage, 60% at early-to-moderate stage, and 6% at moderate-to-advanced stage. 71% of respondents diagnose glaucoma in patients who visit an ophthalmologist independently, 29% diagnose glaucoma in the course of prophylactic medical examinations. 46% of respondents report that IOP measurements during prophylactic medical examinations in adults result in more often diagnosis of glaucoma at early stages. 26% diagnose glaucoma more often but at later stages while 28% do&nbsp; not diagnose glaucoma more often. Conclusions: currently, glaucoma is diagnosed more often at early stages but mainly in patients who visit an ophthalmologist independently. This is the result either of poor coverage of the population by prophylactic medical examinations or their poor quality. Revision of fundamental approach to glaucoma screening is required, i.e., switch from mass screening using tonometry (which is characterized by high percentage of errors) to target screening using advanced diagnostic tools. Keywords: prophylactic medical examinations, screening, medical prevention, chronic noninfectious disorders, glaucoma, risk factors, early stage. For citation: Kazanfarova M.A., Alekseev I.B., Lindenbraten A.L., Kochergin S.A. Improving effectiveness of glaucoma screening during prophylactic medical examinations: current approaches. Russian Journal of Clinical Ophthalmology. 2019;19(3):122–127. About the authors: 1,2Marina&nbsp;A.&nbsp;Kazanfarova — MD, postgraduate student, Project Manager of the International Medical Cluster Foundation, ORCID iD 0000-0001-7401-9538; 1Igor&nbsp;B.&nbsp;Alekseev — MD, PhD, Professor, ORCID iD 0000-0002-4506-4986; 3Aleksandr&nbsp;L.&nbsp;Lindenbraten — MD, PhD, Professor, ORCID iD 0000-0003-3335-7893; 1Sergey&nbsp;A.&nbsp;Kochergin — MD, PhD, Professor, ORCID iD 0000-0002-8913-822X. 1Russian Medical Academy of Continuous Professional Education. 2/1, Barrikadnaya str., Moscow, 125993, Russian Federation. 2&nbsp;The International Medical Cluster Foundation. 35–1, Usachev str., Moscow, 119048, Russian Federation. 3N.A.&nbsp;Semashko National Research Institute of Public Health. 12–1, Vorontsovo Pole str., Moscow, 105064, Russian Federation. Contact information:&nbsp;Marina&nbsp;A.&nbsp;Kazanfarova, e-mail:&nbsp;[email protected].&nbsp;Financial Disclosure:&nbsp;no author has a financial or property interest in any material or method mentioned. There is no&nbsp;conflict of interests. Received&nbsp;15.04.2019. </p

Retinal status in moderate myopia and age-related macular degeneration. Management strategies

L.K. Moshetova1, I.B. Alekseev1–3, I.V. Vorob’eva1,2, Yu.A. Nam3 1Russian Medical Academy of Continuous Professional Education, Moscow, &nbsp;Russian Federation 2S.P. Botkin City Clinical Hospital, Moscow, Russian Federation 3Treatment Rehabilitation Center of the Ministry of Economic Development, Moscow, &nbsp;Russian Federation Aim: to assess retinal status in comorbid ocular disorders (moderate myopia and age-related macular degeneration/AMD of various stages) using modern diagnostic tools. Patients and Methods: 48 patients (96 eyes) with moderate myopia and dry AMD were enrolled. Best-corrected visual acuity (BCVA), mean deviation/MD (characterizes mean reduction of sensitivity), pattern standard deviation/PSD (characterizes the severity of local visual field defects), central macular thickness (CMT), and axial length (AL) were measured. The macular zone was investigated by optical coherence tomography (OCT) using B scan and fundus autofluorescence (FAF) regimens. Results: in moderate myopia associated with dry AMD (AREDS categories 1,2,3), a significant reduction in the mean BCVA (20/25) was detected in 54.2% (26 patients, 52 eyes). Retinal photosensitivity indices (MD and PSD) were also significantly reduced to 2.19 dB (р&lt;0.001) and 2.14 dB (р&lt;0.001), respectively. AL was significantly increased (25.11 mm, р&lt;0.001). No significant differences in CMT values were revealed (233 mcm, p=0.123). In comorbid ocular disorders, severe defects and focuses of RPE atrophy, extensive areas of the IS/OS junction line damage, and drusen are seen among morphological abnormalities of the eye fundus. FAF identified certain pathological patterns, e.g., focal hypo- and hyperautofluorescence, hyperautofluorescent halo at the border of staphyloma, linear hypoautofluorescent bands surrounded with hyperautofluorescence, reticular pattern, patches, focal and multifocal areas of geographic atrophy. Conclusion: our findings on visual field loss (MD, PSD) in AMD depending on stage and OCT findings in AMD are in line with the results of other authors. Meanwhile, we investigated a comorbid variant (AMD in association with moderate myopia), compared morphological and functional parameters, and addressed the relevance of FAF. Keywords: myopia, age-related macular degeneration, optical coherence tomography, autofluorescence. For citation: Moshetova L.K., Alekseev I.B., Vorob’eva I.V., Nam Yu.A. Retinal status in moderate myopia and age-related macular degeneration. Management strategies. Russian Journal of Clinical Ophthalmology. 2022;22(2):91–98 (in Russ.). DOI: 10.32364/2311-7729-2022-22-2-91-98. <br

IOP-lowering effect of glaucoma surgery: retrospective analysis

I.B. Alekseev1, M.M. Soshina2, K.I.&nbsp;Bel'skaja1, A.K. Ajlarova1,2, Yu.G. Kopchenova3, I.A. Koroleva4, A.R. Isaev1 1Russian Medical Academy of Continuous Professional Education, Moscow, Russian &nbsp;Federation 2Moscow City Ophthalmological Center of S.P.&nbsp;Botkin City Clinical Hospital, Moscow, Russian Federation 3City Clinical Hospital No. 52, Moscow, Russian Federation 4City Clinical Hospital No. 15, Moscow, Russian Federation Aim: to assess IOP-lowering effect of the first glaucoma surgery depending on disease stage, age, and sex as well as IOP-lowering medication regimen before re-surgery. Patients and Methods: retrospective analysis of inpatient and outpatient medical records of 93 patients who underwent glaucoma re-surgery was performed. Results: mean interval between two glaucoma surgeries was 83 months (89.2 months in men and 76.6 months in women). The duration of IOP-lowering effect of the first glaucoma surgery (depending on disease stage) was 84 months at stage 1, 93.6 months at stage 2, 80.4 months at stage 3, and 62.7 months at stage 4. Tonography was performed in 32 of 93 patients (34.4%). Outflow facility coefficient (C) was 0.03 to 0.18 mm3/min/mm Hg (on average, 0.08 mm3/min/mm Hg). Minute volume of the aqueous (F) was 0.1 to 1.6 mm3/min (on average, 0.56 mm3/min). Becker’s coefficient was 89 to 933 (on average, 287.9). Conclusions: female sex, older and senile age, and advanced disease stage reduce the duration of IOP-lowering effect of glaucoma surgery. Critical flicker fusion rate is more informative tool to assess optic nerve in case of optical opacities. Informative value of tonography in postoperative patients is less than in naive patients. Nevertheless, tonography provides valuable data on intraocular hydrodynamics and the effects of IOP-lowering drugs (in particular, when prescribed or changed). It was demonstrated that prostaglandin analogues are the major group of topical IOP-lowering medications (86%). The more advanced disease stage was, the more groups of topical IOP-lowering medications were prescribed before re-surgery. Keywords: glaucoma, glaucoma surgery, intraocular pressure, IOP-lowering effect, tonography, prostaglandin analogues, β-blockers. For citation: Alekseev I.B., Soshina M.M., Bel'skaja K.I. et al. IOP-lowering effect of glaucoma surgery: retrospective analysis. Russian Journal of Clinical Ophthalmology. 2020;20(1):–14. DOI: 10.32364/2311-7729-2020-20-1-8-14. <br

РЕКОМЕНДАЦИИ ПО ВЕДЕНИЮ ПЕРВИЧНЫХ ПАЦИЕНТОВ С СИМПТОМАМИ ДИСПЕПСИИ

Aim: To develop evidence-based recommendations for primary care physicians and general practitioners (GP) on choosing the proper management tactics and making valuable & quick diagnostic decisions at outpatient phase for patients with symptoms of dyspepsia, and also reveal possible oncology on time. Summary of recommendations: Approximately 40% of the patients in Russia presenting to primary care with symptoms of dyspepsia. A doctor has to focus on the warning signs, which may require an urgent additional examination & the consultation with a surgeon/onco-surgeon or other specialists if required. With regard to a risk of cancer, a doctor should be more cautious in patients over 45 years of age. Early diagnosis of oncology depends mainly on cautiousness of GP, primary care physicians and their knowledge, future tactics with regard to the patients. From the mandatory diagnostic tests during the first visit, esophagogastroduodenoscopy and H. pylori diagnostics helps to exclude any organic esophagus and stomach pathology, possible oncology. While waiting for endoscopy results, a physician should use the preliminary diagnoses “Uninvestigated Dyspepsia” (ICD-10 К 31.9) (disease of stomach and duodenum, unspecified). After exclusion of all warning signs, therapy of dyspepsia should be in accordance to the order of the Ministry of Health No 248 which gives an option to use proton pump inhibitors (omeprazole or rabeprazole 20 mg daily) in combination with prokinetic (domperidone 30 mg daily). Fixed drug combination of omeprazole 20 mg and modified-release domperidone 30 mg/daily (Omez® DSR) is medically reasonable. Conclusion: The introduction of this recommendation into clinical practice will help clinicians to prevent diagnostic mistakes, unreasonable use of expensive diagnostic examinations and inappropriate treatment leads to improvement in the overall prognosis and quality of life for the patients.Цель. Представить рекомендации диагностики и лечения пациентов с симптомами диспепсии на этапе амбулаторно-поликлинической помощи, обобщающие зарубежный и отечественный опыт ведения данной категории больных. Основная цель рекомендаций - помочь терапевту и врачу общей практики (ВОП) на амбулаторном этапе принять правильное решение о тактике ведения больного, и в максимально короткий срок поставить правильный диагноз, а также вовремя выявить у пациента наличие онкологической патологии. Основные положения. Около 40% обращений пациентов на амбулаторно-поликлиническом приеме в России связано с симптомами диспепсии. Врач, в первую очередь, должен исключить наличие «тревожных признаков», которые требуют незамедлительного дополнительного обследования пациента, привлечения хирурга и/или других специалистов и госпитализации больного. Доктор должен иметь онкологическую настороженность, особенно, при обращении пациентов в возрасте 45 лет и старше, так как ранняя диагностика злокачественных новообразований (ЗНО) зависит главным образом от онкологической настороженности терапевтов, врачей общей практики и их знаний, дальнейшей тактики в отношении больного. Эзофагогастродуоденоскопия и тесты на H. pylori являются обязательными методами исследования на этапе диагностического поиска и позволяют исключить органические заболевания пищевода и желудка, наличие онкологии. До получения результатов эндоскопического исследования следует выставлять предварительный диагноз «Диспепсия Неуточненная» и шифровать под рубрикой МКБ-10 К 31.9 (болезнь желудка и двенадцатиперстной кишки неуточненная). После исключения «тревожных признаков» терапия диспепсии проводится согласно Приказу МЗ РФ № 248 и включает назначение ингибиторов протонной помпы (омепразол или рабепразол 20 мг/сут) в комбинации с прокинетиком (домперидон 30 мг/сут). Оправдано применение фиксированной комбинации омепразола 20 мг с домперидоном модифицированного высвобождения 30 мг/сут (Омез® ДСР). Заключение. Внедрение рекомендаций в клиническую практику поможет врачу избежать ошибок при постановке диагноза, применения необоснованных и нередко дорогостоящих методов обследования, нерационального лечения, что позволит улучшить прогноз и качество жизни пациентов